Original Title: Ajustement des antidépresseurs pour le suivi d’un trouble dépressif caractérisé (majeur) ou d’un trouble anxieux

Authors' objectives: Antidepressants are the first line of pharmacological treatment for many mental health problems, including major depressive disorder and anxiety disorders. Major depressive disorder and anxiety disorders, which often occur concurrently, affect around 1.5 million Canadians each year. The use of antidepressants requires regular follow-up to assess the patient's condition, monitor side effects and optimize treatment. To improve the delivery of care, Bill 90 amended the Professional Code to enable collaborative sharing of healthcare expertise, and the Institut national d'excellence en santé et en services sociaux (INESSS) developed a National Medical Protocol (NMP) for the adjustment of antidepressants, the latest version of which dates from June 2019. The Ministère de la Santé et des Services sociaux (MSSS) has now mandated the INESSS to update this NMP.

Authors' results and conclusions: RESULTS: At the end of the analysis of all the information gathered and the iterative process with stakeholders, the following key findings and messages were recognized as promising for supporting the harmonization of clinical practice and facilitating the management of people with a major depressive disorder or an anxiety disorder who have started antidepressant treatment. (#1 EXPANDING THE SCOPE OF THE NMP CLINICAL SITUATION): Given the high prevalence of generalized anxiety disorder, social anxiety disorder and panic disorder, their frequent concomitance with major depressive disorder, and the similar management of these mental health problems, which includes the use of antidepressants, these anxiety disorders have been added to the NMP clinical situation. (#2 REGULAR MONITORING DURING THE ACUTE PHASE IS IMPORTANT FOR OPTIMAL MANAGEMENT): To facilitate interprofessional intervention, the use of validated measurement scales should be encouraged to monitor depressive and anxiety symptoms, as well as functioning, which is an important element in assessing recovery. • It is also important to reinforce the adoption of healthy lifestyle habits and to document changes in non-pharmacological approaches, as these can directly influence the evolution of the person's symptoms. (#3 THERAPEUTIC ADJUSTMENT TO INDIVIDUAL NEEDS AND PREFERENCES): Taking an antidepressant can have certain undesirable effects, which can be difficult to bear and compromise further treatment. The presence of undesirable effects must first be considered, following the initiation of an antidepressant and each time the dose is increased. • In the absence of intolerable side effects, reaching the minimum therapeutic dose is the first step, followed by maintaining this dose for a sufficient period to observe the expected benefits. CONCLUSION: The updated NMP for adjusting antidepressants in the follow-up of major depressive disorder and anxiety disorders is based on clinical practice recommendations that have been enhanced by the perspective of the stakeholders consulted and contextualized in relation to Quebec practice. This tool should enable practice to be enhanced and harmonized, which will depend on: • dissemination of the updated NMP; • adherence to the changes and appropriation of the recommendations by the healthcare professionals involved; • establishment of winning conditions for interprofessional work in the various care environments, particularly on the front line; • availability of training when needed, and • promoting these tools within the network.

Authors' methods: A systematic review of the literature on the best clinical practices for adjusting antidepressants during the follow-up of a major depressive disorder or anxiety disorders was conducted according to usual INESSS standards. Information analysis was conducted to contextualize practice in Quebec, based in particular on elements of the legislative, regulatory and organizational context specific to Quebec, and then on the perspective of various stakeholders consulted. To gather the stakeholders' perspective, an Advisory Committee was formed, made up of clinicians from various specialties and areas of expertise. Finally, the overall quality of the work, its acceptability and applicability were evaluated by external readers specializing in the field of interest, as well as by future users who had not participated in the work.

Authors' identified further research: The relevance of updating the recommendations will be evaluated four years from the date of publication, based on the advancement of scientific data and the evolution of clinical practices, the listing of new drugs or significant changes in the criteria for reimbursement by the public drug insurance plan, as well as the needs of the health and social services network.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/ajustement-des-antidepresseurs-pour-le-suivi-dun-trouble-depressif-caracterise-majeur-ou-dun-trouble-anxieux.html

URL for protocol: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Ordonnances_collectives/Trouble_depressif/INESSS-Protocole-medical-antidepresseurs.pdf

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/ajustement-des-antidepresseurs-pour-le-suivi-dun-trouble-depressif-caracterise-majeur-ou-dun-trouble-anxieux.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)